Evaluating the Impact of Overactive Bladder on Sexual Health in Women: What Is Relevant?

Benefit of pelvic floor muscle therapy in improving sexual function in women with stress urinary incontinence: a pretest-posttest intervention study

Very few data are available on the effect of pelvic floor muscle training on sexual function in incontinent women. The authors used the Female Sexual Function Index to assess the effect of pelvic floor muscle training on female sexual function. Participants included women with stress urinary incontinence, without overactive bladder symptoms, who completed a 3-month pelvic floor muscle training. All patients completed the Female Sexual Function Index and the International Consultation on Incontinence Questionnaire-Short Form at baseline and at the 3-month follow-up. Thirty-four patients completed all of the questionnaires; 64.7% patients were referred with stress urinary incontinence without sexual disorders, while 35.3% complained of stress urinary incontinence and sexual symptoms. The International Consultation on Incontinence Questionnaire-Short Form score significantly decreased after 3 months of pelvic floor muscle training (p =.01). The Female Sexual Function Index score significantly improved after pelvic floor muscle training even in women with sexual disorders (12.5 ± 9.5 vs. 29.7 ± 3.7; p <.001). This study showed that pelvic floor muscle training may improve female sexual function in women with pure stress urinary incontinence.

Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome/interstitial cystitis

OBJECTIVES

To examine the prevalence and correlates of general and bladder pain syndrome/interstitial cystitis (BPS/IC)-specific sexual dysfunction among women in the RAND Interstitial Cystitis Epidemiology study using a probability sample survey of U.S. households. Sexual dysfunction can contribute to a reduced quality of life for women with bladder pain syndrome/interstitial cystitis (BPS/IC).

METHODS

We telephoned 146,231 households to identify women who reported bladder symptoms or a BPS/IC diagnosis. Those who reported either underwent a second-stage screening using the RAND Interstitial Cystitis Epidemiology study high-specificity symptom criteria. The criteria were pain, pressure, or discomfort in pelvic area; daytime urinary frequency ≥10 times or urgency due to pain, pressure, or discomfort (not fear of wetting); pain that worsened as the bladder filled; bladder symptoms did not resolve after antibiotic treatment; and patients never treated with hormone injections for endometriosis. Women who met the RAND Interstitial Cystitis Epidemiology criteria (n = 1469) completed measures of BPS/IC-specific and general sexual dysfunction symptoms, bladder symptom severity, general physical health, depression, medical care-seeking, and sociodemographic characteristics.

RESULTS

Of those with a current sexual partner (75%), 88% reported ≥1 general sexual dysfunction symptom and 90% reported ≥1 BPS/IC-specific sexual dysfunction symptom in the past 4 weeks. In the multivariate models, BPS/IC-specific sexual dysfunction was significantly associated with more severe BPS/IC symptoms, younger age, worse depression symptoms, and worse perceived general health. Multivariate correlates of general sexual dysfunction included non-Latino race/ethnicity, being married, and having depression symptoms.

CONCLUSIONS

The results of our study have shown that women with BPS/IC symptoms experience very high levels of sexual dysfunction. Also, sexual dysfunction covaries with symptoms.

Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women

INTRODUCTION AND HYPOTHESIS

This study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females.

METHODS

A multi-component questionnaire was mailed to 576 female hospital workers. It contained the Female Sexual Function Index (FSFI) and a self-administered questionnaire pertaining to LUTS.

RESULTS

Of the 276 responses (overall response rate, 47.9%), 146 questionnaires were evaluable. LUTS had been experienced by 72 (49.3%) of the respondents, 17 (11.6%) had urge urinary incontinence, and 35 (24.0%) had stress urinary incontinence (SUI). The mean overall FSFI score was 22.4 ± 9.0. The mean FSFI score was not significantly different between women with LUTS and women without LUTS (23.2 ± 9.3 and 21.6 ± 8.8, respectively; P = 0.057). However, the mean FSFI score of women with SUI was significantly lower than that of women without it (P = 0.04). No other symptoms showed significant differences in FSFI scores.

CONCLUSIONS

Our results suggest that sexual dysfunction is related to SUI.

Sexual function improvement following surgery for stress incontinence: the relevance of coital incontinence

INTRODUCTION

Little is known about the impact of surgery for stress urinary incontinence (SUI) on female sexual function, and results are conflicting.

AIMS

We aimed to clarify the impact of surgery for SUI on female sexual function.

METHODS

We analyzed data collected from two studies evaluating sexual function in women after placement of the tension-free vaginal tape, tension-free vaginal tape obturator, or transobturator suburethral tape. A nonvalidated sexual questionnaire developed by Lemack, translated into Dutch, was mailed to all patients 3-12 months after the procedure.

MAIN OUTCOME MEASURES

Pre- and postoperative results of a nonvalidated sexual questionnaire.

RESULTS

A total of 136 sexually active women completed the questionnaires. Compared with preoperative responses, we observed no significant changes postsurgical regarding frequency of sexual intercourse or satisfaction of sexual intercourse, although a significant postoperative decrease in urinary coital incontinence (P < or = 0.001) was found. Postoperatively, 29 women (21.3%) reported improved sexual intercourse, and eight women (5.9%) complained of a worsening. There was a significant higher rate of preoperative coital incontinence (86.2% women with coital incontinence) in the group of women who reported improved intercourse (P = 0.01).

CONCLUSION

Women with coital incontinence show a significant higher improvement in sexual function after surgery for SUI compared to women without coital incontinence. Our results suggest that improvement in coital incontinence results in improvement of sexual function. Therefore, coital incontinence is a prognostic factor for improvement of sexual function following incontinence surgery.

Sexual dysfunction in women: what can urologists contribute?

Urologists have led the basic science and clinical research of organic-based issues in male sexual dysfunction. Concerning scientific, evidence-based, biologic-focused information, the field of sexual dysfunction in women is relatively new compared with sexual dysfunction in men. Basic science, epidemiology, physiology, pathophysiology, diagnosis, and treatment data on women's sexual health issues are now more regularly published than ever before, with the urologic community once again leading the way. This article reviews some pioneering, resourceful, creative, and novel contributions that urologists have made to enhance the understanding of sexual dysfunction in women. As is obvious in infertility treatment, sexual medicine health care requires biologic and psychologic attention to both members of the couple. The goal of all sexual medicine health care providers is to provide the best health care delivery to women and men with sexual health concerns.

RETRACTED: Evaluation of the safety and efficacy of bremelanotide, a melanocortin receptor agonist, in female subjects with arousal disorder: a double-blind placebo-controlled, fixed dose, randomized study

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Editor-in-Chief. Following the retraction of Dr. Safarinejad's work by other journals, The Journal of Sexual Medicine has undertaken an extensive re-review of all papers Dr. Safarinejad published with the journal. Following an intensive re-evaluation and close scrutiny of the manuscripts, our expert reviewers raised multiple concerning questions about the methodology, results, and statistical interpretation as presented in this article. Dr. Safarinejad was contacted to provide his original data and offer explanations to address the concerns expressed by the reviewers. Dr Safarinejad chose not to respond. Consequently, we can no longer verify the results or methods as presented and therefore retract the article.

Premenopausal women with sexual dysfunction: the need for a bladder function history

INTRODUCTION

Despite the high prevalence of both female sexual problems and bladder dysfunction in the premenopausal population, sexual history forms used in primary care offices rarely include questions about the impact of bladder dysfunction on sexual health.

AIM

To provide a review of the literature that illustrates the relationship between bladder problems and sexual performance of premenopausal women.

MAIN OUTCOME MEASURES

To objectively support by a review of the literature the need for a complete bladder history in when evaluating premenopausal women with female sexual dysfunction.

METHODS

Pubmed was searched for all articles (from November 1980 to June 2007) that reported on the effect bladder dysfunction has on premenopausal female sexual function.

RESULTS

The scant literature available strongly suggested that bladder dysfunction is a contributor to sexual dysfunction and that this medical concern should be considered in all women, regardless of age who present with sexual complaints.

CONCLUSION

Further studies need to be conducted in order to solidify a direct causal relationship between bladder dysfunction and premenopausal female sexuality. These studies should include a larger sample size, clearly defined types of sexual dysfunction and bladder dysfunction, and appropriate follow-up of patient responses using validated objective and subjective outcome modalities to confirm that the patient responses are factual.

Improvement in sexual functioning in patients with interstitial cystitis/painful bladder syndrome

INTRODUCTION

Sexual functioning is one of the strongest predictors of poorer quality of life (QOL) in patients diagnosed with interstitial cystitis/painful bladder syndrome (IC/PBS).

AIMS

To examine the relationship between symptom reduction and sexual functioning in patients with IC/PBS.

METHODS

Patients with IC/PBS were treated with 300 mg/day pentosan polysulfate sodium for 32 weeks.

MAIN OUTCOME MEASURES

Patients completed the O'Leary-Sant Interstitial Cystitis Symptom Index, Short Form-12 QOL, and Medical Outcomes Study Sexual Functioning Scale at baseline, and at 8, 16, 24, and 32 weeks. Treatment responders were defined as those achieving a >/=30% reduction in symptom index from baseline.

RESULTS

A total of 128 patients were included in the analyses. At baseline, mean symptom index, QOL (physical and mental), and sexual functioning scores were 12.3, 41.7, 45.9, and 56.1, respectively. Patients showed statistically significant improvement in symptom and sexual functioning scores at weeks 8, 16, 24, and 32. At week 32, the mean change in symptom index score from baseline was -2.97 (standard deviation [SD] = 4.66, P < 0.0001), and the mean change in sexual functioning score from baseline was 8.9 (SD = 32.9, P = 0.0054). Reduction in symptom index score was moderately correlated with improvement in sexual functioning score at the end of study (r = -35, P = 0.0002). Positive correlation was observed at the end of the study between the mean change scores of sexual functioning score and physical and mental QOL components (r = 0.46, P < 0.0001 and r = 0.29, P = 0.0023, respectively). Patients achieving a >/=30% reduction in symptom index (responder, N = 47; 44%) had an adjusted mean change in sexual functioning score of 19.8 (standard error [SE] = 4.69), while nonresponders (N = 59, 56%) had an adjusted mean change -0.49 (SE = 4.17) (between groups, P = 0.0020).

CONCLUSIONS

Sexual dysfunction is moderate to severe in patients with IC/PBS and impacts significantly on QOL. Reduction in symptoms was associated with improvement in the patient-reported outcomes of sexual function.

Overactive bladder and women's sexual health: what is the impact?

INTRODUCTION

Overactive bladder (OAB) is quite prevalent and significantly affects health-related quality of life and daily functioning.

AIM

The impact of OAB on sexual health is currently not known. This qualitative study was conducted to gain a thorough understanding of OAB's impact.

METHODS

Sexually active women with continent or incontinent OAB were recruited from urology and urogynecology clinics. Six focus groups of women (three continent and three incontinent) were conducted to assess the sexual health of women with OAB. Data were analyzed descriptively and qualitatively.

MAIN OUTCOME MEASURES

Qualitative data, Sexual Quality of Life Questionnaire-Female, Overactive Bladder Questionnaire.

RESULTS

Thirty-four women (11 continent; 23 incontinent) participated; mean age was 48.4 years; 76% were white, 67% postmenopausal, and 88% in a long-term relationship. Continent women reported more frequent sexual activity than incontinent women; 91% reported intercourse >or=1-3 times per month vs. 50% of incontinent women. Half of the incontinent women reported a reduction in sexual desire related to OAB, aging, and menopause. Over half of continent women experienced pain with intercourse, and the majority complained of having to interrupt intercourse to void. Although not all incontinent women reported incontinence during intercourse, the majority were embarrassed by their incontinence and OAB with resulting loss of self-image. Both continent and incontinent women reported difficulty achieving orgasm because of pain, fear of incontinence, or anxiety related to intercourse. Approximately a third of the women would not initiate discussion of sexual issues with their physicians, but all women expressed concern about the impact of OAB on their sexual life.

CONCLUSION

Overactive bladder with or without incontinence negatively affects women's sexual health, reducing sexual desire and ability to achieve orgasm. Given the impact of OAB on sexual health, sexual health should be routinely assessed by clinicians and addressed by researchers.